Modular manipulator support for robotic surgery

ABSTRACT

A robotic surgery system comprises a mounting base, a plurality of surgical instruments, and an articulate support assembly. Each instrument is insertable into a patient through an associated minimally invasive aperture to a desired internal surgical site. The articulate support assembly movably supports the instruments relative to the base. The support generally comprises an orienting platform, a platform linkage movably supporting the orienting platform relative to the base, and a plurality of manipulators mounted to the orienting platform, wherein each manipulator movably supports an associated instrument.

BACKGROUND OF THE INVENTION

The present invention is generally related to medical, surgical, and/orrobotic devices and systems. In an exemplary embodiment, the inventionprovides minimally invasive robotic surgery systems having improvedstructures for supporting and aligning robotic manipulators, such asmanipulators for moving a surgical instrument, an endoscope or otherimage capture device, with desired surgical sites in a patient body.

Minimally invasive medical techniques are intended to reduce the amountof extraneous tissue which is damaged during diagnostic or surgicalprocedures, thereby reducing patient recovery time, discomfort, anddeleterious side effects. One effect of minimally invasive surgery, forexample, is reduced post-operative hospital recovery times. Because theaverage hospital stay for a standard open surgery is typicallysignificantly longer than the average stay for an analogous minimallyinvasive surgery, increased use of minimally invasive techniques couldsave millions of dollars in hospital costs each year. While many of thesurgeries performed each year in the United States could potentially beperformed in a minimally invasive manner, only a portion of the currentsurgeries use these advantageous techniques due to limitations inminimally invasive surgical instruments and the additional surgicaltraining involved in mastering them.

Minimally invasive robotic surgical or telesurgical systems have beendeveloped to increase a surgeon's dexterity and avoid some of thelimitations on traditional minimally invasive techniques. Intelesurgery, the surgeon uses some form of remote control, e.g., aservomechanism or the like, to manipulate surgical instrument movements,rather than directly holding and moving the instruments by hand. Intelesurgery systems, the surgeon can be provided with an image of thesurgical site at the surgical workstation. While viewing a two or threedimensional image of the surgical site on a display, the surgeonperforms the surgical procedures on the patient by manipulating mastercontrol devices, which in turn control motion of the servo-mechanicallyoperated instruments.

The servomechanism used for telesurgery will often accept input from twomaster controllers (one for each of the surgeon's hands) and may includetwo or more robotic arms on each of which a surgical instrument ismounted. Operative communication between master controllers andassociated robotic arm and instrument assemblies is typically achievedthrough a control system, such as those described in U.S. Pat. Nos.6,364,888 and 6,424,885, the full disclosures of which are incorporatedherein by reference. The control system typically includes at least oneprocessor which relays input commands from the master controllers to theassociated robotic arm and instrument assemblies and back from theinstrument and arm assemblies to the associated master controllers inthe case of, e.g., force feedback or the like. Mapping of the handmovements to the image displayed from the image capture device can helpprovide the surgeon with more control over movement of the surgicalinstruments. One example of a robotic surgical system is the DA VINCI®system available from Intuitive Surgical, Inc. of Sunnyvale, Calif.

The servo-mechanically driven linkage is sometimes referred to as arobotic surgical manipulator. Exemplary linkage arrangements for use asa robotic surgical manipulator during minimally invasive robotic surgeryare described in U.S. patent application Ser. No. 10/957,077 and U.S.Pat. Nos. 6,758,843 and 5,800,423, the full disclosures of which areincorporated herein by reference. These linkages make use of aparallelogram arrangement to hold an instrument having a shaft. Such amanipulator structure can mechanically constrain movement of theinstrument so that the instrument pivots about a point of sphericalrotation positioned in space along the length of the rigid shaft. Byaligning this pivot point with the incision point to the internalsurgical site (for example, with a trocar or cannula at an abdominalwall during laparoscopic surgery), an end effector of the surgicalinstrument can be moved without imposing dangerous forces against theabdominal wall. Alternative manipulator structures are described, forexample, in U.S. Pat. Nos. 6,702,805; 6,676,669; 5,855,583; 5,808,665;5,445,166; and 5,184,601, the full disclosures of which are incorporatedherein by reference.

A variety of structural arrangements can also be used to support andposition the robotic surgical manipulator and the surgical instrument atthe surgical site during robotic surgery. Supporting linkage mechanisms,sometimes referred to as set-up joint arms, are often used to positionand align each manipulator with the respective incision point in apatient's body. The supporting linkage mechanism facilitates thealignment of a surgical manipulator with a desired surgical incisionpoint. Exemplary supporting linkage mechanism are described in U.S. Pat.Nos. 6,246,200 and 6,788,018, the full disclosures of which areincorporated herein by reference.

While the new telesurgical systems and devices have proven highlyeffective and advantageous, still further improvements would bedesirable. In general, it would be desirable to provide improvedminimally invasive robotic surgery systems. It would be particularlybeneficial if these improved technologies enhanced the efficiency andease of use of robotic surgical systems. For example, it would beparticularly beneficial to increase maneuverability, improve spaceutilization in an operating room, provide a faster and easier set-up,inhibit collisions between robotic devices during use, and/or reduce themechanical complexity and size of these new surgical systems.

BRIEF SUMMARY OF THE INVENTION

The present invention is generally related to medical, surgical, and/orrobotic devices and systems. In many embodiments, the present inventionprovides minimally invasive robotic surgery systems having improvedstructures for supporting and aligning robotic manipulators, such asmanipulators for moving a surgical instrument, an endoscope or otherimage capture device, with desired surgical incision sites in apatient's body. Improved modular manipulator support can provide severaladvantages, including increased maneuverability, improved spaceutilization in an operating room, a faster and easier set-up, collisioninhibition between robotic devices during use, and/or reduced mechanicalcomplexity and size of these new surgical systems. Such advantages inturn enhance the efficiency and ease of use of such robotic surgicalsystems.

In a first aspect of the present invention a robotic surgery systemcomprises a mounting base, a plurality of surgical instruments, and anarticulate support assembly. Each instrument is insertable into apatient through an associated minimally invasive aperture to a desiredinternal surgical site. The articulate support assembly movably supportsthe instruments relative to the base. The support generally comprises anorienting platform, a platform linkage movably supporting the orientingplatform relative to the base, and a plurality of manipulators mountedto the orienting platform, wherein each manipulator movably supports anassociated instrument.

The mounting base preferably comprises a ceiling supported structure soas to permit the articulate support assembly to extend generallydownward from the base. A ceiling mounted articulate support assemblyadvantageously improves space utilization in an operating room,particularly clearing up space adjacent the operating table forpersonnel and/or other surgical equipment as well as minimizing roboticequipment and cabling on the floor. Further, a ceiling mountedarticulate support assembly minimizes the potential for collisions orspace conflicts with other adjacent manipulators during a procedure andprovides for convenient storage when the robotic surgery system is notin use.

The platform linkage preferably comprises a linear rail, a slidablecarriage coupleable to the rail, and at least one arm rotationallycoupleable to the carriage on a proximal end and to the orientingplatform on a distal end. The platform linkage advantageously enhancesmaneuverability of the articulate support assembly by accommodatingtranslation of the orienting platform in at least three dimensions aswell as rotation of the orienting platform about one axis. The orientingplatform's enhanced range of motion permits access to incision sitesover a wide range of the patient's body. This may be beneficial whenperforming complicated and lengthy procedures, such as colon surgery,multi-vessel coronary bypass graft procedures, heart surgery, gastricbypass, and the like, by facilitating quick repositioning of themanipulators mid-operation to alternative surgical sites.

The robotic surgery system further includes a plurality of configurableset-up joint arms coupleable to the orienting platform. Each arm ismovably supporting an associated manipulator and defines releasablyfixable links and joints that are pre-configurable. In many embodiments,three or more manipulators will be mounted to the orienting platform,often being four or more manipulators, each manipulator being associatedwith a separate incision site. Each of the four or more incision sitesis about 7-15 mm in diameter, and may be considered to be a point, whichis typically located at a midpoint of an abdominal wall in the abdomenor next to a rib in the thorax. Preferably, the orienting platformcomprises four hubs rotationally coupleable to the plurality of arms anda fifth hub coupleable to the platform linkage, wherein the fifth hub isaligned with a pivot point, which is preferably coincident with theincision site for the endoscope. The fifth hub provides for rotation ofthe orienting platform about this endoscope manipulator pivot point toallow the plurality of set-up arms to point in the direction in which asurgical procedure is to take place.

Generally, the orienting platform supports three set-up joint arms formovably supporting instrument manipulators and one set-up joint arm formovably supporting an image capture device manipulator. Utilization ofthe orienting platform to support the individually positionable set-uparms and associated manipulators advantageously results in a relativelysmall and compact manipulator support structure that is mechanicallyless complex. For example, the single orienting platform can allow for afaster and easier set-up by avoiding delays and complexities associatedwith independently configuring each set-up arm.

Each set-up joint arm is simplified in that it has no more than fourdegrees of freedom. Typically, each arm accommodates translation of thefixable links and joints in one dimension and rotation of the fixablelinks and joints about two or three axes. At least one set-up joint armincludes at least one balanced, fixable, jointed parallelogram linkagestructure extending between a pair of adjacent fixable rotationaljoints. The jointed parallelogram structure accommodates motion in agenerally vertical direction, and the adjacent rotational jointsaccommodate pivotal motion about vertical axes.

The system may further include a brake system coupled to the articulatesupport assembly. The brake system releasably inhibits articulation ofthe fixable links and joints previously configured in at leastsubstantially fixed configuration. The brake system is biased toward thefixed configuration and includes a brake release actuator for releasingthe fixable links and joints to a repositionable configuration in whichthe fixable links and joints can be articulated. The system may furtherinclude a joint sensor system coupling a plurality of the fixable linksand joints to a servomechanism. The sensor system generates jointconfiguration signals. The servomechanism includes a computer and thejoint sensor system transmits the joint configuration signals to thecomputer. The computer calculates a coordinate system transformationbetween a reference coordinate system affixed relative to the mountingbase and the instruments using the joint configuration signals.

At least one manipulator is mechanically constrained so that amanipulator base is at a fixed angle relative to horizontal. The atleast one manipulator supported by the set-up joint arm is angularlyoffset relative to horizontal in a range from 40 degrees to about 60degrees, preferably from about 45 degrees to about 50 degrees. The atleast one manipulator supported by the set-up joint auxiliary arm isangularly offset relative to horizontal in a range from 0 degrees toabout 20 degrees, preferably by about 15 degrees. The at least onemanipulator supported by the set-up joint center arm is angularly offsetrelative to horizontal in a range from 40 degrees to about 90 degrees,preferably from about 65 degrees to about 75 degrees.

Preferably, at least one manipulator comprises an offset remote centerlinkage for constraining spherical pivoting of the instrument about apivot point in space, wherein actuation of the fixable links and jointsof the set-up joint arm moves the pivot point. Surprisingly, the set-uparms may be simplified (e.g., with no more than four degrees of freedom)due to the increased range of motion provided by the offset remotecenter manipulators. This allows for a simpler system platform with lesspre-configuration of the set-up joint arms. As such, operating roompersonnel may rapidly arrange and prepare the robotic system for surgerywith little or no specialized training. Exemplary offset remote centermanipulators providing for reduced mechanical complexity of the set-uparms are described in further detail in U.S. patent application Ser. No.10/957,077.

In one embodiment, the offset remote center manipulator generallycomprises an articulate linkage assembly having a manipulator base,parallelogram linkage base, a plurality of driven links and joints, andan instrument holder. The manipulator base is rotationally coupled tothe parallelogram linkage base for rotation about a first axis. Theparallelogram linkage base is coupled to the instrument holder by theplurality of driven links and joints. The driven links and joints definea parallelogram so as to constrain an elongate shaft of the instrumentrelative to a pivot point when the instrument is mounted to theinstrument holder and the shaft is moved in at least one degree offreedom. The first axis and a first side of the parallelogram adjacentthe parallelogram linkage base intersect the shaft at the pivot point,and the first side of the parallelogram is angularly offset from thefirst axis.

In another aspect of the present invention, a modular manipulatorsupport for use in a robotic surgery system is provided. The systemcomprises a mounting base, a plurality of surgical instruments, and aplurality of manipulators defining driven links and joints for moving anassociated instrument so as to manipulate tissues. The support formovably supporting and positioning the manipulator relative to the baseincludes an orienting platform coupleable to the mounting base and aplurality of arms coupleable to the orienting platform. Each arm movablysupports an associated manipulator and defines releasably fixable linksand joints that are pre-configurable. The support may further include adisplay, such as in interactive monitor, coupleable to the orientingplatform. This display may be used for set-up purposes, instrumentchanges, and/or for personnel viewing of a procedure.

In yet another aspect of the present invention, a robotic surgery systemcomprises a ceiling-height mounting base, a plurality of surgicalinstruments, and an articulate support assembly movably supporting theinstruments relative to the base. The assembly comprising an orientingplatform and a plurality of arms associated with a plurality ofmanipulators. The orienting platform is coupleable to the base so as topermit the articulate support assembly to extend generally downward fromthe base. The plurality of arms are coupleable to the orientingplatform, wherein each arm defines releasably fixable links and jointsthat are pre-configurable. The plurality of manipulators are coupleableto the arms, each manipulator defining driven links and joints formoving the instruments so as to manipulate tissues.

In still another aspect of the present invention, methods for preparinga robotic surgery system having a mounting base, a plurality of surgicalinstruments, and an articulate support assembly movably supporting theinstruments relative to the base are provided. One method comprisingmoving an orienting platform to pre-position a plurality of manipulatorsmounted to the orienting platform by articulating a platform linkagemovably supporting the orienting platform relative to the base so thatthe surgical instruments supported by the manipulators are orientatedtowards associated minimally invasive apertures. Movement of theorienting platform may comprise translating the orienting platform inthree dimensions and/or rotating the orienting platform about one axis.The plurality of manipulators may be moved by articulating a pluralityof arms coupleable to the orienting platform. The platform linkage,orienting platform, and/or the arms may be restrained with brake systemsso as to prevent further articulation.

A further understanding of the nature and advantages of the presentinvention will become apparent by reference to the remaining portions ofthe specification and drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

The following drawings should be read with reference to the detaileddescription. Like numbers in different drawings refer to like elements.The drawings, which are not necessarily to scale, illustratively depictembodiments of the present invention and are not intended to limit thescope of the invention.

FIG. 1 is a schematic plane view of a portion of an operating theaterillustrating a robotic surgical system, including a master surgeonconsole or workstation for inputting a surgical procedure and a roboticpatient side cart for robotically moving surgical instruments havingsurgical end effectors at surgical sites.

FIG. 2 is a perspective view of the robotic patient side cart or stand,including positioning linkages which allow two patient side roboticmanipulators and one endoscope camera robotic manipulator to bepre-configured.

FIGS. 3A and 3B are side and front views, respectively, of the linkageof the robotic manipulators of FIG. 2.

FIG. 4 is a perspective view of an articulated surgical instrument foruse in the system of FIG. 1.

FIGS. 5A and 5B are perspective views from above of an exemplary modularmanipulator support constructed in accordance with the principles of thepresent invention.

FIGS. 6A and 6B are perspective views of the set-up joint arm and theset-up joint auxiliary arm, respectively, of the manipulator support ofFIG. 5A.

FIGS. 7A through 7D are perspective views from above and below of theorienting platform of the manipulator support of FIG. 5A.

FIGS. 8A and 8B are perspective views from below and above of a platformlinkage for movably supporting the manipulator support of FIG. 5A.

FIGS. 9A through 9G illustrate perspective and top views of the set-upjoint center arm supporting and positioning an endoscope camera roboticmanipulator.

FIGS. 10A through 10H illustrate perspective and top views of the set-upjoint arm supporting and positioning a patient side robotic manipulator.

FIGS. 11A through 11D illustrate perspective and top views of the set-upjoint auxiliary arm supporting and positioning a patient side roboticmanipulator.

FIGS. 12A through 12C illustrate perspective views from above of fourset-up joint arms showing the action of the redundant degrees offreedom.

DETAILED DESCRIPTION OF THE INVENTION

FIGS. 1 through 4 illustrate a robotic surgical system 1 for performingminimally invasive robotic surgery, which is described in more detail inU.S. Pat. No. 6,246,200. An operator O (generally a surgeon) performs aminimally invasive surgical procedure on patient P lying on operatingtable T, the operator O manipulating one or more input devices ormasters 2 at a surgeon's console 3. In response to the surgeon's inputs,a computer processor 4 of console 3 directs movement of endoscopicsurgical instruments or tools 5, effecting servo-mechanical movement ofthe instruments via a robotic patient side system 6 (a cart-mountedsystem in this example).

Typically, patient side system or cart 6 includes at least three roboticmanipulator arms. Two set-up joint arms or linkages 7 (mounted at thesides of cart 6 in this example) support and position servo-manipulators8 which drive surgical tools 5; and one set-up joint arm or linkage 9(mounted at the center of cart 6 in this example) supports and positionsservo-manipulator 10 which controls the motion of an endoscope cameraprobe 11, which captures an image (preferably stereoscopic) of theinternal surgical site.

The image of the internal surgical site is shown to surgeon or operatorO by a stereoscopic display viewer 12 in surgeon's console 3, and issimultaneously shown to assistant A by an assistant's display 14.Assistant A assists in pre-positioning the manipulator 8 and 10 relativeto patient P using set-up linkage arms 7, 9, in swapping tools 5 in oneor more of surgical manipulator 8 (and/or 10) for alternative surgicaltools or instruments 5′, in operating related non-robotic medicalinstruments and equipment, and the like.

In general terms, the arms or linkages 7, 9 comprise a positioninglinkage or set-up arm portion of patient side system 6, typicallyremaining in a fixed configuration while tissue is manipulated, and themanipulators 8, 10 comprise a driven portion which is activelyarticulated under the direction of surgeon's console 3. The manipulators8, 10 are primarily used for master/slave tissue manipulation, while theset-up arms 7, 9 are used for positioning and/or configuring themanipulators 8, 10 before use, when repositioning the patient, operatingtable, incision points, and the like.

For convenience in terminology, a manipulator such as 8 actuating tissueaffecting surgical tools is sometimes referred to as a PSM (patient sidemanipulator), and a manipulator such as 10 controlling an image captureor data acquisition device, such as endoscope 11, is sometimes referredto as an ECM (endoscope-camera manipulator), it being noted that suchtelesurgical robotic manipulators may optionally actuate, maneuver andcontrol a wide variety of instruments, tools and devices useful insurgery.

FIG. 2 illustrates a perspective view of the cart mounted telesurgicalpatient side system 6 of FIG. 1, including two PSM's 8 and one ECM 10.Cart system 6 includes a column 15 which in turn mounts threepositioning linkages or set-up arms, including two PSM set-up arms 7,each supporting one of the PSM's 8, and one ECM set-up arm 9 supportingECM 10. The PSM set-up arms 7 each have six degrees of freedom, and aremounted one on each side of centrally mounted ECM set-up arm 9. The ECMset-up arm 9 shown has less than six degrees of freedom, and ECM 10 maynot include all of the tool actuation drive system provided forarticulated surgical instruments, such as are typically included in PSM8. Each PSM 8 releasably mounts surgical tool 5 (shown in dashed lines)and ECM 10 releasably mounts endoscope probe 11 (shown in dashed lines).

FIGS. 3A and 3B are side and front views, respectively, of the linkageof the robotic surgical manipulator or PSM 8 of FIG. 2, having a remotecenter mechanism. PSM 8 is one prior art example of a manipulator whichmay be mounted and supported by a cart mount 6, ceiling mount, orfloor/pedestal mount. In this example, the PSM 8 preferably includes alinkage arrangement 20 that constrains movement of tool interfacehousing 21 and mounted instrument or tool 5. More specifically, linkage20 includes rigid links coupled together by rotational joints in aparallelogram arrangement so that housing 21 and tool 5 rotate around apoint in space 22, as more fully described in issued U.S. Pat. No.6,758,843.

The parallelogram arrangement of linkage 20 constrains rotation topivoting, as indicated by arrow 22 a in FIG. 3A, about an axis,sometimes called the pitch axis, which is perpendicular to the page inthat illustration and which passes through pivot point 22. The linkssupporting the parallelogram linkage are pivotally mounted to set-upjoint arms (7 in FIG. 2) so that tool 5 further rotates about an axis 22b (FIG. 3B), sometimes called the yaw axis. The pitch and yaw axesintersect at the remote center 22, which is aligned along a shaft 23 oftool 5. Tool 5 has still further driven degrees of freedom as supportedby manipulator 8, including sliding motion of the tool along insertionaxis 22 c. Tool 5 includes proximal housing 24 which mounts tomanipulator interface housing 21. Interface housing 21 both provides formotion of the tool 5 along axis 22 c and serves to transfer actuatorinputs to tool 5 from the end effector actuator servo-mechanisms of PSM8. In this example of a remote center system, the parallelogramarrangement 20 is coupled to tool 5 so as to mechanically constrain thetool shaft 23 to rotation about pivot point 22 as the servomechanismactuates tool motion according to the surgeon's control inputs.

As tool 5 slides along axis 22 c relative to manipulator 8, remotecenter 22 remains fixed relative to mounting base 25 (mounting point toset-up arm 7) of manipulator 8. Hence, the entire manipulator 8 isgenerally moved to re-position remote center 22. Linkage 20 ofmanipulator 8 is driven by a series of motors 26 (FIG. 3A). These motorsactively move linkage 20 in response to commands from a processor (4 inFIG. 1). Motors 26 are further coupled to tool 5 so as to rotate thetool about axis 22 c, and may articulate a wrist (29 in FIG. 4) at thedistal end of the tool 5 about at least one, and often two, degrees offreedom. Additionally, motors 26 can be used to actuate an articulatableend effector of the tool for grasping tissues in the jaws of a forcepsor the like. Motors 26 may be coupled to at least some of the joints oftool 5 using cables, as more fully described in U.S. Pat. No. 5,792,135,the full disclosure of which is also incorporated herein by reference.As described in that reference, the manipulator 8 will often includeflexible members for transferring motion from the drive components tothe surgical tool 5. For endoscopic procedures, manipulator 8 will ofteninclude a cannula 27. Cannula 27, which may be releasably coupled tomanipulator 8, supports tool 5, preferably allowing the tool to rotateand move axially through the central bore of the cannula 27.

FIG. 4 illustrates an exploded perspective view of the articulatedsurgical tool or instrument 5 and proximal housing 24, that may beemployed in the system of FIG. 1. Tool 5 includes elongate shaft 23supporting end effector 28 relative to proximal housing 24. Proximalhousing 24 is adapted for releasably mounting and interfacing instrument5 to a manipulator (e.g., PSM 8 in FIGS. 1, 2, 3A, and 3B), and fortransmitting drive signals and/or motion between the manipulator 8 andend effector 28. An articulated wrist mechanism 29 may provide twodegrees of freedom of motion between end effector 28 and shaft 23, andthe shaft 23 may be rotatable relative to proximal housing 24 so as toprovide the end effector 28 with three substantially orientationaldegrees of freedom within the patient's body.

Referring now to FIGS. 5A and 5B, perspective views from above of anexemplary modular manipulator support assembly 30 constructed inaccordance with the principles of the present invention are illustrated.The modular manipulator support 30 aligns and supports roboticmanipulators, such as patient side manipulators 32 or endoscope cameramanipulators 34, with a set of desired surgical incision sites in apatient's body. The modular manipulator support assembly 30 generallyincludes an orienting platform 36 and a plurality of configurable set-upjoint arms 38, 40, 42, 44 coupleable to the orienting platform 36. Eacharm 38, 40, 42, 44 is movably supporting an associated manipulator 32,34 which in turn movably supports an associated instrument. It will beappreciated that the above depictions are for illustrative purposes onlyand do not necessarily reflect the actual shape, size, or dimensions ofthe modular manipulator support assembly 30. This applies to alldepictions hereinafter.

The orienting platform 36 generally supports two set-up joint arms 40,42 (SJA1 right and SJA2 left) and one optional auxiliary arm 44 (SJX)for movably supporting the associated patient side manipulators 32.Typically, each arm accommodates translation of the patient sidemanipulator in three dimensions (x, y, z) and rotation of the patientside manipulator about one vertical axis (azimuth). Further perspectiveviews of the set-up joint right arm 40 and the set-up joint auxiliaryarm 44 are shown respectively in FIGS. 6A and 6B. Generally, the rightand left arms 40, 42 support manipulators which correspond to the rightand left surgeon controls while the auxiliary or assistant arm 44provides for additional variation in manipulator positioning which is ofparticular benefit during complex surgeries, such as cardiac surgery.The orienting platform 36 further supports one set-up joint center arm38 (SJC) for movably supporting the endoscope camera manipulator 34. Itwill be appreciated that the set-up arms 38, 40, 42, 44 mayinterchangeably support and position instrument 32 or camera 34manipulators. Utilization of the orienting platform 36 to support theindividually positionable set-up arms 38, 40, 42, 44 and associatedmanipulators 32, 34 advantageously results in a simplified singlesupport unit having a relatively scaled down, compact size. For example,the single orienting platform 36 may obviate any need to individuallyarrange and mount each set-up arm 38, 40, 42, 44 to a mounting base,which is often confusing and cumbersome. This in turn allows for afaster and easier set-up.

Referring to FIGS. 6A, 6B, 9A, each set-up joint arm 38, 40, 42, 44defines releasably fixable links and joints that are pre-configurable.In a preferred embodiment, each set-up joint arm 38, 40, 42, 44 includesat least one balanced, fixable, jointed parallelogram linkage structure46 extending between a pair of adjacent fixable rotational joints 48,50. The jointed parallelogram structure 46 accommodates motion in agenerally vertical direction, and the adjacent rotational joints 48, 50accommodate pivotal motion about vertical axes as described in moredetail below. One or more linear or curved sliding axes could be used inlieu of any or all of the rotary ones. Each of the parallelogramstructures 46 may have a generally similar structure, in this examplecomprising a link 52 of variable length, a proximal bracket 54, and adistal bracket 56. The link 52 is pivotally jointed to proximal anddistal brackets 54, 56 respectively in a vertically-oriented planarparallelogram configuration. This permits rotational motion of the link52 in the vertical plane, while constraining the brackets 54, 56 toremain substantially parallel to one another as the parallelogram 46deforms by joint rotation 48, 50. As shown in FIG. 6A, an additionallink 58 may be rotationally coupled by an additional pivot 60 for set-upjoint arms 40, 42. An additional auxiliary link 62 of longer length maybe rotationally coupled by an additional auxiliary pivot 64 for set-upjoint auxiliary arm 44. As shown in FIG. 9A, the set-up joint center arm38 will comprise a relatively short, rigid arm defined primarily by theparallelogram structure 46. The set-up joint arms 38, 40, 42, 44 may bebalanced by a variety of mechanisms including weights, tension springs,gas springs, torsion springs, compression springs, air or hydrauliccylinders, torque motors, or combinations thereof.

Each set-up joint arm 38, 40, 42, 44 has surprisingly simplifiedkinematics (e.g., with no more than four degrees of freedom) due to theimproved range of motion provided by the manipulators 32, 34. Typically,the arms accommodate translation of the fixable links and joints in agenerally vertical direction as denoted by arrow SJC 3 for arm 38 inFIG. 5A, arrow SJA1 3 for arm 40 in FIG. 6A, and arrow SJX 3 for arm 44in FIG. 6B. The arms also accommodate rotation of the fixable links andjoints about two or three vertical axes. As seen in FIG. 6A, arrows SJA11, SJA1 2, and SJA1 4 illustrate the rotational joints 60, 48, 50respectively of the set-up joint arm 40. The translational androtational axes for the left set-up joint arm 42 (SJA2) is identical tothat of the right arm 40 (SJA1) illustrated in FIG. 6A. FIG. 6B denotesthe rotational joints 64, 48, 50 of the set-up joint auxiliary arm 44 byarrows SJX 1, SJX 2, and SJX 4 respectively. Arrows SJC 2 and SJC 4illustrate the rotational joints 48, 50 respectively of the set-up jointcenter arm 38 in FIG. 5A. The arms 38, 40, 42, 44 may be power operated,computer controlled, manually pre-configured, or a combination thereof.Preferably, joints SJA1 1, SJA2 1, and SJX 1 of the set-up joint arms40, 42 and the auxiliary arm 44 are motorized while the other joints andset-up joint center arm 38 are manually positioned. Motors may belocated within the plurality of fixable links or orienting platform todrive pulley and belt mechanisms.

The fixable joints 48, 50, 62, 64 of the set-up arms 38, 40, 42, 44typically include a brake system to allow the joints to be locked intoplace after the arms are appropriately deployed. The brake systemreleasably inhibits articulation of the fixable links 52, 58, 62 andjoints 48, 50, 62, 64 previously configured in at least substantiallyfixed configuration. The brake system is preferably biased toward thefixed configuration and includes a brake release actuator for releasingthe fixable links 52, 58, 62 and joints 48, 50, 62, 64 to arepositionable configuration in which the fixable links and joints canbe articulated. The system may further include a joint sensor systemcoupling a plurality of the fixable links 52, 58, 62 and joints 48, 50,62, 64 to a servomechanism. The sensor system generates jointconfiguration signals. The servomechanism includes a computer and thejoint sensor system transmits the joint configuration signals to thecomputer. The computer calculates a coordinate system transformationbetween a reference coordinate system affixed relative to a mountingbase and the instruments using the joint configuration signals.

Referring again to FIGS. 6A, 6B, 9A, the manipulators 32, 34 aremechanically constrained so that a manipulator base 66 is at a fixedangle relative to horizontal. As shown in FIG. 6A, the manipulator 32supported by the set-up joint arm 40 is angularly offset relative tohorizontal in a range from 40 degrees to about 60 degrees, preferablyfrom about 45 degrees to about 50 degrees. As shown in FIG. 6B, themanipulator 32 supported by the set-up joint auxiliary arm 44 isangularly offset relative to horizontal in a range from 0 degrees toabout 20 degrees, preferably by about 15 degrees. As shown in FIG. 9A,the manipulator 34 supported by the set-up joint center arm 38 isangularly offset relative to horizontal in a range from 40 degrees toabout 90 degrees, preferably from about 65 degrees to about 75 degrees.

Preferably, the manipulators 32, 34 comprise offset remote centerlinkages for constraining spherical pivoting of the instrument aboutpivot points in space, wherein actuation of the fixable links 52, 58, 62and joints 48, 50, 62, 64 of the set-up joint arms 38, 40, 42, 44 movesthe pivot points. As discussed above, the overall complexity of therobotic surgical system may be reduced due to the improved range ofmotion of the system. Specifically, the number of degrees of freedom inthe set-up joints arms 38, 40, 42, 44 may be reduced (e.g., less thansix degrees of freedom). This allows for a simpler system platformrequiring less pre-configuration of the set-up joint arms 38, 40, 42,44. As such, operating room personnel may rapidly arrange and preparethe robotic system for surgery with little or no specialized training.Exemplary offset remote center manipulators 32, 34 providing for reducedmechanical complexity of the set-up arms 38, 40, 42, 44 are described infurther detail in U.S. patent application Ser. No. 10/957,077.

In the embodiment illustrated in FIGS. 6A, 6B, 9A, the offset remotecenter manipulator 32, 34 generally includes the manipulator base 66, aparallelogram linkage base 68, a plurality of driven links and joints70, 72, and an instrument holder 74. The manipulator base 66 isrotationally coupled to the parallelogram linkage base 68 for rotationabout a first axis, also known as the yaw axis. The parallelogramlinkage base 68 is coupled to the instrument holder 74 by rigid links70, 72 coupled together by rotational pivot joints. The driven links andjoints 70, 72 define a parallelogram so as to constrain an elongateshaft of the instrument or cannula 76 relative to a center of rotation(pivot point) 78 when the instrument is mounted to the instrument holder74 and the shaft is moved along a plane of the parallelogram. The firstaxis and a first side of the parallelogram adjacent the parallelogramlinkage base 68 intersect the shaft at the center of rotation 76,wherein the first side of parallelogram is angularly offset from thefirst axis.

The manipulator base 66 of the surgical manipulators 32, 34 is mountedand supported at a constant elevation angle by set-up arms 38, 40, 42,44, as described above in detail. The manipulator base 66 in thisembodiment is fixed to a manipulator base support 80 of the set-up arms38, 40, 42, 44 by screws or bolts. Although the exemplary set-up arms38, 40, 42, 44 have a manipulator base support 80 suited to the geometryof a remote center manipulator 32, 34, manipulator base support 80 maytake on a variety of alternative support configurations to suit othertelesurgical manipulators. For example, the manipulator base support maybe configured to support further alternative remote center manipulators,natural center manipulators, computed center manipulators, softwarecenter manipulators, and manipulators employing a combination of thesefunctional principles. Further, as noted above, the manipulator basesupport 80 of the set-up arms 38, 40, 42, 44 may interchangeably supportand position instrument 32 or camera 34 manipulators.

Referring now to FIGS. 7A through 7D, further perspective views fromabove and below of the orienting platform 36 are illustrated. Theorienting platform 36 comprises a generally horizontal grand pianoshaped platform having four hubs 82, 84, 86, 88 rotationally coupleableto the plurality of arms 38, 40, 42, 44 respectively, as shown in theview from below of FIGS. 7B and 7C. In particular, rotational joint 48of set-up joint center arm 38 supporting the endoscope cameramanipulator 34 is rotationally coupled to hub 82 which offset to theside of the orienting platform 36. The rotational joints 60 of the rightand left set-up joint arms 40, 42 supporting the patient sidemanipulators 32 are rotationally coupled to hubs 84, 86 respectively ofthe orienting platform 36. Lastly, the rotational joint 64 of set-upjoint auxiliary arm 44 supporting the patient side manipulator 32 isrotationally coupled to hub 88. Hub 88 is on the midline of theorienting platform 36 so that the auxiliary arm 44 may be utilized oneither the left or rights side. In the case of a five set-up joint armsupport, a hub may be positioned on each side of the midline similar tothe positioning of hubs 84 and 86 with an auxiliary arm for the rightside and another auxiliary arm for the left side. The shape of theorienting platform 36 as well as the relative locations of the hubs 82,84, 86, 88, 90 further contribute to the increased maneuverability ofthe system as well as collision inhibition between arms and/ormanipulators.

As shown in FIGS. 7A and 7D, a fifth hub 90 is coupleable to a platformlinkage 92, as discussed in more detail with respect to FIGS. 8A and 8Bbelow. The fifth hub 90 is aligned with the pivot point 78 of the set-upjoint center arm 38, which is preferably coincident with its incisionsite for the endoscope. The fifth hub 90 provides for rotation of theorienting platform 36 about a vertical axis as denoted by arrow SJC 1 inFIG. 5A. Rotation of the orienting platform 36 about the pivot point 78of the endoscope manipulator 34 which is aligned with the surgicalincision advantageously allows for increased maneuverability of theorienting platform 36 and associated set-up arms 38, 40, 42, 44 in thedirection in which a surgical procedure is to take place. This is ofparticular benefit during complex surgeries, as manipulator 32, 34positioning may be varied mid-operation by simply rotating the orientingplatform 36 about the fifth hub 90. Typically, the instruments will beretracted prior to rotation for safety purposes. For small rotations ofthe orienting platform 36 or tilting of the operating table, the lowfriction and balanced arms 40, 42, 44 may float while attached to thecannula during movement, pushed by force from the incisions.

Rotation of the orienting platform 36 about hub 90 (SJC 1), rotation ofthe set-up joint arms 40, 42 about hubs 84, 86 (SJA1 1), and rotation ofthe set-up joint auxiliary arm 44 about hub 88 (SJX 1) is preferablypower operated, but may alternatively be manual or computer controlled.Motors driving belt and pulley mechanisms 94 for orienting platformrotation (SJC 1) are within the orienting platform as shown in FIG. 7C.A brake system may also be included to allow the orienting platform 36to be locked into place. Motors driving belt and pulley mechanisms 96,98, 100 for right, left, and auxiliary set-up arm rotation (SJA1 1, SJX1) 40, 42, 44 respectively are also within the orienting platform 36 asshown in FIG. 7D. FIGS. 7C and 7D further illustrate electronic modulecontrols 102 for each associated set-up arm 38, 40, 42, 44.

The orienting platform 36 may further include a display 104, such as ininteractive monitor, as shown in FIGS. 7A and 7B. This display 104 maybe used for set-up purposes, instrument changes, and/or for personnelviewing of a procedure. The display 104 is preferably adjustably mountedto the orienting platform 36 with a parallelogram linkage 106 so thatpersonnel can view the monitor in a desired direction.

Referring now to FIGS. 8A and 8B, perspective views from below and aboveof the platform linkage 92 for movably supporting the orienting platform36 at hub 90 are illustrated. The platform linkage 92 generallycomprises a linear rail 108, a slidable carriage 110 coupleable to therail 108, and at least one arm 112 rotationally coupleable to thecarriage 110 on a proximal end 114 and to the orienting platform 36 viahub 90 on a distal end 116. The platform linkage 92 advantageouslyenhances maneuverability of the modular manipulator support 30 byaccommodating translation of the orienting platform 36 in threedimensions (x, y, z). Movement of the orienting platform in a generallyhorizontal direction is denoted by arrow OP 1. Movement of the orientingplatform in a generally vertical direction is denoted by arrow OP 2.Movement of the orienting platform in and out of the page is articulatedby rotational movement of joint 120, as denoted by arrow OP 3. Theplatform linkage 92 further accommodates rotation of the orientingplatform 36 about one vertical axis, as denoted by arrow SJC 1. The arm112 preferably comprises a four bar parallelogram linkage 118 extendingbetween a pair of adjacent joints 120, 122. It will be appreciated thatalthough the fifth hub 90 accommodates rotation of the orientingplatform 36 (SJC 1), the system may also be designed wherein the fifthhub 90 is rotationally coupleable to the platform linkage 92 so that theplatform linkage accommodates pivotal motion of the orienting platform.

The orienting platform's 36 enhanced range of motion due to the platformlinkage 92 permits access to incision sites over a wide range of thepatient's body. This of particular benefit when performing complicatedand lengthy procedures, where the manipulators 32, 34 may be quicklyrepositioned mid-operation to alternative surgical sites. Typically, theinstruments will be retracted prior to translation or rotation of theorienting platform 36 for safety purposes. The platform linkage 92 ispreferably power operated, but may alternatively be manual or computercontrolled. Motors may be located within the platform linkage 92 ororienting platform 36 to drive pulley and belt mechanisms. For example,motors driving belt and pulley mechanisms 94 with harmonic drives fororienting platform rotation about hub 90 (SJC 1) are within theorienting platform as shown in FIG. 7C. A brake system may also beincluded to allow the platform linkage 92 to be locked into place.

As shown in FIG. 8B, the platform linkage 92 is preferably mounted to amounting base via bolts and brackets 124 or other conventional fastenerdevices. The mounting base preferably comprises a ceiling-height supportstructure so as to permit the manipulator support assembly 92, 30 toextend generally downward from the base. A ceiling-height mountedmanipulator support assembly advantageously improves space utilizationin an operating room, particularly clearing up space adjacent theoperating table for personnel and/or other surgical equipment as well asminimizing robotic equipment and cabling on the floor. Further, aceiling-height mounted manipulator support assembly minimizes thepotential for collisions or space conflicts with other adjacentmanipulators during a procedure and provides for convenient storage whenthe robotic surgery system is not in use.

The term “ceiling-height support structure” includes support structuresdisposed on, adjacent, or within an operating room ceiling and includessupport structures disposed substantially below an actual ceilingheight, especially in the case of a higher-than-typical operating roomceiling. The mounting base permits the manipulator support assembly 92,30 to be stored by pulling it against the wall, using joints as shown inFIGS. 8A and 8B. The mounting base may include existing architecturalelements, such as original or reinforced structural elements, joists, orbeams. Further, the mounting base may be formed from sufficiently rigidand stiff materials to inhibit vibration. Alternatively, passive meanssuch as viscous or elastomer dampers or active means such asservo-mechanisms may be used to counteract vibration or interfloormovement of the hospital building in vertical and/or horizontaldirections.

Referring now to FIGS. 9A and 9B, oblique views of the set-up jointcenter arm 38 supporting the endoscope camera robotic manipulator 34 areshown. FIG. 9C illustrates a top view. As discussed above, the set-upjoint center arm 38 comprises a relatively short, near vertical rigidarm defined primarily by the parallelogram structure 46. The set-upjoint center arm 38 has a shorter parallelogram link 52 than the otherthree arms 40, 42, 44. The set-up joint center arm 38 has three degreesof freedom (SJC 2, SJC 3, SJC 4) that are typically manually positioned.The set-up joint center arm 38 is free of any redundant joints as theazimuth angle is controlled by the rotation of the orienting platform36. FIGS. 9D and 9E illustrate translation of the set-up joint centerarm 38 as denoted by arrow SJC 3. FIGS. 9F and 9G illustrate rotationalmotion of the set-up joint center arm 38 as denoted by arrow SJC 4.

Referring now to FIGS. 10A and 10B, oblique and top views of the set-upjoint arm 40 supporting the patient side robotic manipulator 32 areshown. As discussed above, the set-up joint arm 40 has four degrees offreedom (SJA1 1, SJA1 2, SJA1 3, SJA1 4), wherein the SJA1 1 joint ismotorized and the other joints are manually positioned. FIGS. 10C and10D illustrate rotational motion of the set-up joint arm 40 as denotedby arrow SJA1 2. FIGS. 10E and 10F illustrate translation of the set-upjoint arm 40 as denoted by arrow SJA1 3. FIGS. 10G and 10H illustrateboth translational and rotational motion of the set-up joint arm 40 asdenoted by arrows SJA1 3, and SJA1 4. The translational and rotationalaxes for the left set-up joint arm 42 (SJA2) is identical to that of theright arm 40 (SJA1)

Referring now to FIGS. 11A and 11B, oblique and top views of the set-upjoint auxiliary arm 44 supporting the patient side robotic manipulator32 are shown. As discussed above, the set-up joint auxiliary arm 44 issimilar in kinematics to the set-up joint arm 40, but is longer inlength and has a shallower angle as its hub 88 is on an end of theorienting platform 36. The set-up joint auxiliary arm 44 has fourdegrees of freedom (SJX 1, SJX 2, SJX 3, SJX 4), wherein the SJX 1 jointis motorized and the other joints are manually positioned. FIGS. 11C and11D illustrate rotational motion of the set-up joint auxiliary arm 44 asdenoted by arrow SJX 4.

Referring now to the FIGS. 12A, 12B and 12C, perspective views fromabove of the four set-up joints 38, 40, 42, 44 without the orientingplatform 36 are illustrated. These depictions illustrate the action ofredundant degrees of freedom, altering the azimuth angle, which movesthe patient side manipulator 32 farther or closer to the endoscopecamera manipulator 34. In operation, once the motorized joint positionsSJA1 1, SJA2 1, and SJX 1 are set, typically to preset values, the userhas only to align each remote center of the patient side manipulatorwith each incision. This may be done by attaching each patient sidemanipulator to the associated cannula which is already positioned withinthe incision. This automatically sets the set-up joint positions, asthere is no remaining redundancy. The low friction and balancing ofthese three joints allows the patient side manipulators to float so thateach manipulator can be controlled by holding it advantageously at asingle point. Setting a motorized joint to a different position willresult in a different azimuth angle for the patient side manipulatorafter the cannula is attached. In other words, the function of theredundant, motorized joint is to allow the patient side manipulatorfarther from or closer to another patient side manipulator or endoscopemanipulator. Alternatively, after the cannula is attached, the azimuthcan be adjusted by operating the motor while the set-up joint brakes arereleased and the cannula is held at the incision.

Although certain exemplary embodiments and methods have been describedin some detail, for clarity of understanding and by way of example, itwill be apparent from the foregoing disclosure to those skilled in theart that variations, modifications, changes, and adaptations of suchembodiments and methods may be made without departing from the truespirit and scope of the invention. Therefore, the above descriptionshould not be taken as limiting the scope of the invention which isdefined by the appended claims.

What is claimed is:
 1. A method for preparing a robotic surgery systemhaving a mounting base, a plurality of surgical instruments, and anarticulate support assembly movably supporting the instruments relativeto the base, the method comprising: moving an orienting platform topre-position a plurality of manipulators mounted to the orientingplatform by articulating a platform linkage movably supporting theorienting platform relative to the base so that the surgical instrumentssupported by the manipulators are orientated towards associatedminimally invasive apertures; wherein the platform linkage comprises alinear rail, a slidable carriage coupleable to the rail, and at leastone arm rotationally coupleable to the carriage on a proximal end and tothe orienting platform on a distal end.
 2. The method of claim 1,wherein moving comprises translating the orienting platform in threedimensions.
 3. The method of claim 1, wherein moving comprises rotatingthe orienting platform about one axis.
 4. The method of claim 1, furthercomprising moving the plurality of manipulators by articulating aplurality of arms coupleable to the orienting platform.
 5. The method ofclaim 1, further comprising restraining the platform linkage, orientingplatform, or arms with a brake system so as to prevent furtherarticulation.
 6. An articulate support assembly comprising: an orientingplatform comprising a bottom surface; a plurality of set-up joint arms,each of the arms coupleable to the orienting platform through arotatable hub attached to said bottom surface, at least one of theplurality of arms comprising a plurality of configurable linkages andjoints comprising: at least one parallelogram linkage structure formoving a distal end of the arm in a vertical direction.
 7. The assemblyof claim 6, further comprising a platform linkage rotationally coupledto the orienting platform.
 8. The assembly of claim 7, at least onerotatable hub coupleable to the platform linkage at a pivot point, theorienting platform rotatable about the pivot point.
 9. The assembly ofclaim 7, the plurality of hubs comprising four hubs.
 10. The assembly ofclaim 7, the distal end of each arm coupleable to a manipulator.
 11. Theassembly of claim 6, each of the plurality of arms comprising at leastone parallelogram linkage structure for moving a distal end of the armin a vertical direction.
 12. The assembly of claim 6, each parallelogramlinkage structure comprising: a proximal bracket; a distal bracket; anda linkage pivotally jointed to the proximal and distal brackets.
 13. Theassembly of claim 6, the plurality of links and joints furthercomprising: at least one linkage coupled to a rotational joint.
 14. Theassembly of claim 13, the at least one linkage coupled to a rotationaljoint comprising an auxiliary linkage rotationally coupled to the restof the plurality of links and joints by an auxiliary pivot.
 15. Theassembly of claim 13, at least one joint being motorized.
 16. Theassembly of claim 6, the at least one joint comprising a brake to lockthe corresponding joint into place.
 17. The assembly of claim 6, furthercomprising a display coupled to the orienting platform.
 18. Anarticulate support assembly comprising: an orienting platform; aplurality of set-up joint arms, each of the arms coupleable to theorienting platform through a rotatable hub, at least one of theplurality of arms comprising a plurality of configurable linkages andjoints comprising: at least one parallelogram linkage structure formoving a distal end of the arm in a vertical direction; the assemblyfurther comprising a platform linkage rotationally coupled to theorienting platform; the platform linkage comprising a linear rail, aslidable carriage coupleable to the rail, and at least one armrotationally coupleable to the carriage on a proximal end and to theorienting platform on a distal end.
 19. An articulate support assemblycomprising: an orienting platform; a plurality of set-up joint arms,each of the arms coupleable to the orienting platform through arotatable hub, at least one of the plurality of arms comprising aplurality of configurable linkages and joints comprising: at least oneparallelogram linkage structure for moving a distal end of the arm in avertical direction; the assembly further comprising a platform linkagerotationally coupled to the orienting platform; the platform linkagecoupled to a mounting base, the mounting base coupled to aceiling-height support structure.
 20. An articulate support assemblycomprising: an orienting platform; a plurality of set-up joint arms,each of the arms coupleable to the orienting platform through arotatable hub, at least one of the plurality of arms comprising aplurality of configurable linkages and joints comprising: at least oneparallelogram linkage structure for moving a distal end of the arm in avertical direction; the assembly further comprising a platform linkagerotationally coupled to the orienting platform; the distal end of eacharm coupleable to a manipulator; each manipulator comprising an offsetremote center linkage for constraining spherical pivoting of aninstrument about a pivot point, the instrument being insertable into thebody of a patient through an aperture.
 21. An articulate supportassembly comprising: an orienting platform; a plurality of set-up jointarms, each of the arms coupleable to the orienting platform through arotatable hub, at least one of the plurality of arms comprising aplurality of configurable linkages and joints comprising: at least oneparallelogram linkage structure for moving a distal end of the arm in avertical direction; the assembly further comprising a platform linkagerotationally coupled to the orienting platform; the distal end of eacharm coupleable to a manipulator; the manipulator coupled to the distalend of each arm by a manipulator base support, the manipulatorcomprising a manipulator base coupled to the manipulator base support.